Conjunctival Melanoma
"No Touch" Excision with Lamellar Sclerokeratectomy
Contributors: James M. Huffman, MD and Mark A. Greiner, MD
Additional Note: Length 02:24
Posted May 31, 2019
This patient presented with a large pigmented conjunctival growth and
underwent excisional biopsy, absolute alcohol application, cryotherapy, and ocular surface reconstruction with amniotic membrane grafting. Pathology was consistent with conjunctival melanoma, primarily epithelioid histology.
- Superior and inferior 7-0 vicryl traction sutures placed to aid with exposure.
- 4mm margins are marked around the lesion.
- Absolute alcohol is applied to the ocular surface for 30 seconds to devitalize atypical surface cells. Basic salt solution is then used to irrigate the ocular surface.
- Superficial keratectomy is performed with a 69-Beaver blade. The corneal epithelium is removed from the central cornea to the periphery.
- The conjunctiva is then excised using a "no-touch" technique. Smooth forceps and Katena scissors are used.
- The underlying Tenon's fascia is then dissected from the conjunctiva. Tenon's is then removed with smooth forceps and Westcott scissors.
- 2mm marks are then placed around the lesion on the sclera and cornea.
- An adjustable diamond radial keratotomy knife is then set to 200 microns and use to start the partial-thickness sclerokeratectomy.
- Lamellar dissection is continued with a 2.5mm crescent blade.
- The lesion is then tagged with a 7.0 vicryl suture and submitted to pathology.
- Absolute alcohol is then applied to the scleral bed for 30 seconds. Basic salt solution is then used to irrigate the ocular surface.
- A double freeze-thaw cycle is then applied to the conjunctiva. -80 degrees centigrade is reached with the cryo probe and then irrigated with basic salt solution.
- Amniotic membrane is then placed stroma-side down and sutured/glued into place with 10-0 vicryl and fibrin glue.
- The 7-0 vicryl suture is then removed and a collagen shield is placed onto the ocular surface.
last updated: 05/31/2019
